Treatment of reflux-nephropathy
Last reviewed: 20.11.2021
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The development of reflux-nephropathy at any degree of PMR is an indication for performing surgical correction of reflux.
Before the intervention, it is necessary to conduct a course of antibiotic therapy to prevent the manifestation or exacerbation of the pyelonephritic process.
With the development of reflux-nephropathy in the pre- or postoperative period, it must be taken into account that this condition occurs against the background of violations of cellular energy of various degrees. Therefore, all children are recommended to use succinic acid preparations (yantovit, mitamine) at 25 mg / day, and in the presence of data on the violation of mitochondrial enzyme activity - the use of an extended treatment regimen using drugs that are aimed at correcting the state of mitochondria. When developing nephrosclerosis, it is advisable to use antisclerotic drugs (vitamin B 15, solcoseryl, stugeron, cytochrome C).
The main drugs used in complex treatment in the presence of signs of mitochondrial insufficiency
|
Name of the drug |
Introduction |
Dosages |
A course of treatment |
|
Yantovit |
Per os. |
25-50 mg / day |
1 -1.5 months. Three days in three days |
|
Mini yantovit |
Per os |
See No. 1 |
Also. |
|
Mitamin |
Per os |
See No. 1 |
Also |
|
Elkar |
Per os |
50-100 mg / kg. |
Zme. |
|
Coenzyme q10 |
Per os |
30-300 mg / day. |
Zme. |
|
Riboflavin |
Per os |
20-150 mg / day. |
1 month |
|
Thiamine |
Per os |
50 mg / day. |
1 month |
|
Pyridoxine |
Per os |
2 mg / kg / day. |
1 month |
|
Lipoic acid |
Per os |
50-100 mg / day. |
1 month |
|
Vitamin E |
Per os |
100-200 mg / day. |
1 month |
|
Dimephosphon |
Per os |
15-20 mg / kg |
1 month |
|
Vitamin B |
Per os |
100 mg / day .. |
1 month |
|
Cytochrome C |
B / m; B / in |
20 mg / day. |
10 days |
|
Solcoseryl |
B / m |
2 ml / day. |
2-3 weeks. |
Conservative treatment should be carried out under constant monitoring of the child's condition with the help of laboratory and instrumental studies (general and biochemical analysis of urine and blood, urine enzymes activity, urea and blood creatinine levels, ultrasound and dopplerographic examination of the kidneys, cystography, cystoscopy, intravenous urography and radioisotope study of the kidneys ).
Dispensary supervision
Children with vesicoureteral reflux and reflux nephropathy should be observed with the nephrologist before transferring to an adult network.
Dispensary observation includes:
- examination by a nephrologist at least once every 6 months;
- control of urine tests 1 time per month. And with intercurrent diseases;
- the general or common analysis of a blood 1 time in 3 months. And with intercurrent diseases;
- biochemical blood test with mandatory determination of the level of urea and creatinine 1 time per bm;
- biochemical analysis of urine 1 time per bm;
- analysis of mitochondrial enzyme activity once a year;
- analysis of urine enzyme activity once a year;
- cystography after the course of therapeutic treatment, then 1 time in 1-3 years;
- cystoscopy according to indications;
- Ultrasound and dopplerography of the kidneys 1 time per bm;
- radioisotope study of the kidneys 1 time per year;
- intravenous urography according to indications;
- angiography of the kidneys according to the indications.
Prevention of the development of vesicoureteral reflux and its complications is as early as possible its diagnosis. This requires an antenatal ultrasound with a degree of pyeloectasia, as well as ultrasound of the kidneys in the neonatal period and in the first year of life.